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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For A Collapsed Urethra

Our good friend was born with a hole in his belly that he urinated from. He went through numerous surgeries to correct the problem. They built a urethra and moved his genitals back in place where they go. He is now 37 years old. His last surgery was in his teens and has no problems until this last year. His urethra has collapsed and he has been living the last year with a tube coming out of his stomach to release urine. He is having problems with infections. No one knows what to do to help him. He also has problems with his sphincter. They don't know where to turn. He is willing to be a guinea pig or a teaching case. He just wants his life back. He leaves everyone scratching their head and saying it is such a complex case. I know that I am giving you a very narrowed down summary of his condition, but just want to know if ANYONE can help.
Fri, 17 Apr 2015
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Pediatric Surgeon,  's  Response
Hi, this is a case of exstrophy epispadias complex. In this entity, the urinary bladder is exposed as there is no anterior abdominal wall. Also the bladder is of small size. So during childhood surgeries are done to close down the anterior abdominal wall defect and make the bladder. The bad thing is that, usually the bladder is of small size and it does not have a proper holding capacity as there is no natural sphincter mechanism. So the people may be leaking urine throughout or during the reconstructive procedure, the sphincter made becomes so tightened that the patient is unable to pass urine and for this alternative drainage procedure is required called mitrofanoff. The management is putting an infant feeding tube no. 8 into the mitrofanoff and draining all the urine from the bladder 2-3 hourly during the day time and connecting the tube to a drainage bag called urosac at night. This procedure is called clean intermittent catheterisation and night drainage. You should ask your urologist for the same and also about how to maintain the antisepsis in the procedure. This is all what can be done and this is done to keep the person dry, odourless and safety of the kidneys.
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Suggest Treatment For A Collapsed Urethra

Hi, this is a case of exstrophy epispadias complex. In this entity, the urinary bladder is exposed as there is no anterior abdominal wall. Also the bladder is of small size. So during childhood surgeries are done to close down the anterior abdominal wall defect and make the bladder. The bad thing is that, usually the bladder is of small size and it does not have a proper holding capacity as there is no natural sphincter mechanism. So the people may be leaking urine throughout or during the reconstructive procedure, the sphincter made becomes so tightened that the patient is unable to pass urine and for this alternative drainage procedure is required called mitrofanoff. The management is putting an infant feeding tube no. 8 into the mitrofanoff and draining all the urine from the bladder 2-3 hourly during the day time and connecting the tube to a drainage bag called urosac at night. This procedure is called clean intermittent catheterisation and night drainage. You should ask your urologist for the same and also about how to maintain the antisepsis in the procedure. This is all what can be done and this is done to keep the person dry, odourless and safety of the kidneys.